Dec 2025

Welcome to the TRIO Student Support Services STEM application!
Thank you for your interest with the program.

Please complete the application below.
*Reminder that if you are UNDER 24 years old, you are REQUIRED to provide parent's financial information and signature.

This application does not allow you to save and go back. You must complete it in its entirety.
Please contact TRIO staff if you prefer a paper version.

You will need:
- 15 minutes to complete application
- Permanent Resident Card (if applicable)
- Tax Form 1040 for your Taxable income (Under 24 yrs old, you will need parent's taxable income)
- Signature to submit (Under 24 yrs old, you will need parent's signature)

First Name *

Last Name *

Middle Name

Preferred First Name

Are you an U.S. Citizen? *

If "No," are you an eligible non-citizen?

Please upload a copy or photo of your Permanent Resident Card (If applicable)

Unfortunately, federal law does not allow TRIO programs to serve students who are not U.S. citizens or legal residents.
For further information, contact the TRIO Center at 303-914-6764 or stop in to talk with any staff member.

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Personal Information

School ID *

Local Address *

Local Address 2

Local City *

Local State *

Local Zip *

Date of Birth *

Cell Phone Number (or landline if you do not have a cell phone) *

RRCC Email Address *

Personal Email Address *

Gender *

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Ethnicity

Ethnicity Hispanic/Latino/a/x/e *

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Race

You must answer YES to at least one category
as per federal requirement

American Indian or Alaskan Native *

Asian *

Black or African American *

White *

Hawaiian or Native to Pacific Island *

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Eligibility

Do you have a documented disability? This includes (but is not limited to) learning differences, neurodivergence, chronic health conditions, and mental health conditions.) *

Are you working with RRCC Accessibility Services?

Do either of your parents have a 4-year college degree?(Or if you regularly resided with only one parent, did they complete a Bachelor's degree?) *

Highest Educational Level of Father *

Highest Educational Level of Mother *

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Academic History

Are you a high school graduate *

If yes, high school name

If yes, month and year of graduation

If no, have you earned a GED?

If yes, month and year received GED

Have you attended a college other than RRCC? *

If yes, college name

Do you have a prior college degree? *

Have you been out of school for more than 5 years?

Do you plan to earn an Associates degree from RRCC? *

If so, what do you plan to study/major in?

Do you plan to transfer to a 4-year college/university? *

If yes, which 4-year college or university do you plan to transfer to??

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Income Verification
PLEASE NOTE: If you are under 24 years of age, you are required to provide information from your parents' tax return
(regardless if you live with them or not).

Did you complete a FAFSA for the current academic year? *

Did you use your parents' taxes or income to complete FAFSA? If yes they must also sign this application. *

Please Select either 2023 or 2024 Tax Form if you filed taxes.

Which year is the Form 1040 used to complete your FAFSA? *

Size of Family Unit entered on taxes? *

From the tax form above, what was taxable income on line 15? Enter N/A if no tax return. Enter 0 if earnings not sufficient. *

Below is a reference for Line 15 from Tax Form 1040

If no tax return, write a statement that details how you supported yourself last year. Include the source of your support.

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RRCC TRIO Student Support Services STEM
Participation Requirements
Please select YES to each statement

I will attend the TRIO SSS Kick-Off Event each semester. *

I will attend at least 3 appointments w/my TRIO Coordinator each semester. *

I will submit the FAFSA for each year I am enrolled at RRCC. *

I will inform RRCC TRIO staff of any changes to my address or phone number. *

I will complete an EXIT Survey when I leave the program. *

I understand that to maintain my TRIO status as an Active Participant I agree to follow through with the above statements to achieve my college success. *

How did you hear about TRIO? *

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Consenting Agreements

1) I give my permission for the RRCC TRIO staff to access my ACADEMIC, FINANCIAL AID RECORDS, AND IF APPLICABLE VERIFYING REGISTRATION WITH ACCESSIBILITY SERVICES for the purpose of verifying my eligibility for TRIO. I understand that the TRIO SSS staff agrees to adhere to all guidelines under FERPA - the Federal Education Rights and Privacy Act. *

2) I give my permission for the RRCC TRIO staff to access my grades electronically for the purpose of supporting me academically at RRCC. I understand that I have access to my academic record at any time. *

3) I understand that services provided by TRIO SSS may be amended or suspended if I violate the RRCC Student Code of Conduct. *

4) I understand that TRIO SSS may photograph, film, or quote TRIO SSS participants for the purpose of program outreach. I permit TRIO SSS to use my image and quotes without reimbursement to me, for publication, electronic media, or other appropriate purposes. *

5) I understand that I must meet the eligibility criteria established by TRIO SSS regulations and policies in order to be accepted into the TRIO SSS program. *

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Signatures

Sign and Submit:

If you are under 24 years of age, your parent must also sign this application!

Terms of Submission:

By submitting this application, you acknowledge that all of the above information is correct and accurate to the best of your understanding.

Application Signature *

Signature Type: Simple Start Over

Signature: (Type in your full name)

I agree to the terms included.

Parent's Signature

Signature Type: Simple Start Over

Signature: (Type in your full name)

I agree to the terms included.